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<title>Cash2u.ca: Please choose your province you are living in</title>
<META NAME="Keywords" CONTENT="payday loan, payday cash advance, online, payday advance, payday cash loan, payday loans, cash advance, paycheque loans, short term,
	money mart, money here, quick cash,check,cashing,easy,tax, bill,payment,currency,card,credit,Easy Cash Advances, Internet Payday loans, Payroll Advance, Payday Loan Services,
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<META NAME="Description" CONTENT=Cash2u.ca offers online payday loans and cash advance for Canadians">

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<div id="maincontainer">

<div id="topsection"><h1><a class="innertube" href="apply.php">Cash to You Now</a></h1></div>

<div id="top_nav">
<ul class="nav_desc">
<li class="nav"><a id="nav_home" href="index.html"><span class="displace">HOME</span></a></li>
<li class="nav"><a id="nav_apply" href="apply.php"><span class="displace">APPLY</span></a></li>
<li class="nav"><a id="nav_existing" href="member.php"><span class="displace">MEMBERS</span></a></li>
<li class="nav"><a id="nav_policy" href="policy.php"><span class="displace">POLICY</span></a></li>
<li class="nav"><a id="nav_FAQ" href="faqs.php"><span class="displace">FAQ's</span></a></li>
<li class="nav"><a id="nav_contact" href="contact.php"><span class="displace">CONTACT</span></a></li>
</ul>
</div>

<div id="content">
    	<div id="Apphead" class="Apphead" style="margin: 20px 0 0 5px;">
        	<h3>LOAN APPLICATION</h3>
		<p>Returning customers, please <a style="color:green;" href="member.php">apply here</a> for a faster application<br/>
		   Please fill all the fields for this online application unless indicated 			as optional </p>
            
    	</div>
        <!-- EOD of Application Head -->    
          
        <div id="TopSectionWrapper" class="PersonalInfo">
		<div id="NewCust" class="NewCust">New Customer NewcustomerID Here</div>

	<!--Starting of Personal Information Section-->
	<div id="TitleInfo" class="TitleInfo"><h2>Your Personal Information - Step 1</h2></div>
	<div id="Topcontainer">
		<div id="Topleft">
			<form name="TopLeft" method="post" id="FTopLeft" class="FTopLeft" action="">
				<p id="Labels">
                                First Name</p>
				<p id="Labels">
                                Last Name</p>
				<p id="Labels">
                                Gender</p>
				<p id="Labels">
                                Date of Birth</p>				
				<p style="margin:5px;padding:3px;margin-top:30px;">
                                Address</p>
				<p id="address"><!--to parallize the position with input-->
                                City</p>
				<p id="address">
                                Province</p>
				<p id="address">
                                Post Code</p>
				<p style="margin:5px;padding:3px;margin-top:20px;">
                                Date moved in</p>
				<p style="margin:5px;padding:3px;margin-top:20px;">
                                Primary Phone</p>
				<p style="margin:5px;padding:3px;margin-top:20px;">
                                Work Phone</p>
				<p style="margin:5px;padding:3px;margin-top:20px;">
                                Cell Phone</p>
			</form>
		</div>
		<div id="TopleftCenter">
			<form name="TopLeftCenter" method="post" id="FTopLeftCenter" class="FTopLeftCenter" action="">
                            	<input type="text" class="textBox" id="fName"  name="fName" /><br/>
	                       	<input type="text" class="textBox" id="fName"  name="lName" /><br />
                            	<input type="radio" name="gender" value="male" id="gender"/>Male
                            	<input type="radio" name="gender" value="female" id="gender"/>Female<br/>
				<div style="margin:5px 0 5px 5px;color:green;">
				<input type="text" class="textBox" id="datebirth"  name="birthdate" /><br />date: mm/dd/yyyy</div>
	                       	<input type="text" class="textBox" id="fName"  name="address" /><br />
	                       	<input type="text" class="textBox" id="fName"  name="city" /><br />
				<input type="text" class="textBox" id="fName"  name="mprovince" value="<?php echo $_POST["province"];?>"/><br />

				<div style="margin:5px 0 5px 5px;color:green;">
	                       	<input type="text" class="textBox" id="post"  name="postcode" /><br />Post Code: A9A-9A9</div>
				<div style="margin:5px 0 5px 5px;color:green;">
				<input type="text" class="textBox" id="datein"  name="datein" /><br />date: mm/dd/yyyy</div>
	        		<div style="margin:5px 0 5px 5px;color:green;">
		               	<input type="text" class="textBox" id="phonep"  name="primaryphone"/><br />Tel: (999) 999-9999</div>
				<div style="margin:5px 0 5px 5px;color:green;">
	                       	<input type="text" class="textBox" id="phonew"  name="workphone" /><br />Tel: (999) 999-9999x99999</div>
				<div style="margin:5px 0 5px 5px;color:green;">
	                       	<input type="text" class="textBox" id="phonec"  name="cellphone" /><br />Tel: (999) 999-9999</div>
			</form>
		</div>
		<div id="TopRightCenter">
			<form name="Toprightcenter" method="post" id="FToprightcenter" class="FToprightcenter" 				action="">
				<p id="LabelsSecond">
                                Social Insurance Number</p>
				<p style="margin:5px;padding:3px;margin-top:25px;">
                                Driver License</p>
				<p id="LabelsSecond">
                                Email Address/loginID</p>
				<p id="addressSecond">
                                Confirm Email Address</p>
				<p id="addressSecond">
                                Password</p>
				<p id="addressSecond"><!--to parallize the position with input-->
                                Confirm Password</p>
				<p id="addressSecond">
                                Where to know Cash2u.ca</p>
				<p id="addressSecond">
                                Reference#1-Name</p>
				<p id="addressSecond">
                                Reference#1-Phone Number</p>
				<p style="margin:5px;padding:3px;margin-top:25px;">
                                Reference#1-Relationship</p>
				<p id="addressSecond">
                                Reference#2-Name</p>
				<p id="addressSecond">
                                Reference#2-Phone Number</p>
			</form>
		</div>
		<div id="TopRight">
			<form name="Topright" method="post" id="FTopright" class="FTopright" action="">
				<div style="margin:5px 0 5px 5px;color:green;">
                            	<input type="text" class="textBox" id="ssn"  name="SIN" /><br/>SIN: 999-999-999</div>
	                       	<input type="text" class="textBox" id="fName"  name="Dlicnese" /><br />
                            	<input type="text" class="textBox" id="fName"  name="email" /><br />
                            	<input type="text" class="textBox" id="fName"  name="emailconfirm" /><br/>
	                       	<input type="password" class="textBox" id="fName"  name="pwd" /><br />
	                       	<input type="password" class="textBox" id="fName"  name="pwdconfirm" /><br />
				<select id="appprovince" style="margin:5px;height:25px;" name="advertisement">
					<option value="">- Select -</option>
					<option value="Cash2u.ca Location" >www.Cash2u.ca</option>
					<option value="Google" >Google</option>
				        <option value="Yahoo" >Yahoo</option>
				        <option value="Email" >E-Mail</option>
				        <option value="InternetS" >Internet Search</option>
				        <option value="Friend" >Friend</option>
            				<option value="Other Websites" >Other Websites</option>
				        <option value="Other Media" >Other Media</option>
				</select>
	                       	<input type="text" class="textBox" id="fName"  name="r1name" /><br />
				<div style="margin:5px 0 5px 5px;color:green;">
	                       	<input type="text" class="textBox" id="phoner1"  name="r1phone" /><br />Tel: (999) 999-9999x99999</div>
	                       	<input type="text" class="textBox" id="fName"  name="r1relation" /><br />
	                       	<input type="text" class="textBox" id="fName"  name="r2name" /><br />
				<div style="margin:5px 0 5px 5px;color:green;">
	                       	<input type="text" class="textBox" id="phoner2"  name="r2phone" /><br />Tel: (999) 999-9999x99999</div>
			</form>
		</div>
		<br style="clear: both;" /> <!-- Included to force the container to wrap the columns --> 
	</div>

	<!--EOD of Personal Information Section-->

	<div id="TitleInfo" class="TitleInfo"><h2>Your Employment Information - Step 2</h2></div>

	<!--Starting Employment Information Section-->
	<div id="Topcontainer">
		<div id="Topleft">
			<form name="TopLeft" method="post" id="FTopLeft" class="FTopLeft" action="">
				<p id="Labels">
                                Employer</p>
				<p id="Labels">
                                Employer Address</p>
				<p id="Labels">
                                Employer City</p>
				<p id="LabelsP">
                                Employer Province</p>
				<p id="address">
                                Employer Phone</p>
				<p style="margin:5px;padding:3px;margin-top:25px;">
                                Employer Post</p>
				<p style="margin:5px;padding:3px;margin-top:30px;">
                                Occupation</p>
				<p id="address">
                                Job Status</p>
			</form>
		</div>
		<div id="TopleftCenter">
		<form name="ETopLeftCenter" method="post" id="FTopLeftCenter" class="FTopLeftCenter" action="">
                            	<input type="text" class="textBox" id="fName"  name="Employer" /><br/>
	                       	<input type="text" class="textBox" id="fName"  name="EAddress" /><br />
	                       	<input type="text" class="textBox" id="fName"  name="ECity" /><br />                					<select id="appprovince" style="margin:5px;height:25px;" name="EProvince">
					<option value="">- Select -</option>
					<option value="Alberta" >Alberta</option>
				        <option value="British Columbia" >British Columbia</option>
				        <option value="Manitoba" >Manitoba</option>
            				<option value="New Brunswick" >New Brunswick</option>
				        <option value="Newfoundland" >Newfoundland</option>
				        <option value="Northwest Territories" >Northwest Territories</option>
				        <option value="Nova Scotia" >Nova Scotia</option>
				        <option value="Nunavut" >Nunavut</option>
				        <option value="Ontario">Ontario</option>
				        <option value="PEI" >PEI</option>
				        <option value="Saskatchewan" >Saskatchewan</option>
				        <option value="Yukon" >Yukon</option>
				</select>
				<div style="margin:5px 0 5px 5px;color:green;">
	                       	<input type="text" class="textBox" id="phoneext"  name="EPhone" /><br />Tel: (999) 999-9999x99999</div>
				<div style="margin:5px 0 5px 5px;color:green;">
	                       	<input type="text" class="textBox" id="epost"  name="EPost" /><br />Post Code: A9A-9A9</div>
	                       	<input type="text" class="textBox" id="fName"  name="Occupation" /><br />
	                       	<select id="appprovince" style="margin:5px;height:25px;" name="JobStatus">
					<option value="">- Select -</option>
					<option value="Full-Time" >Full Time</option>
					<option value="Part-Time" >Part Time</option>
					<option value="Contract" >Contract</option>
					<option value="Seasonally" >Seasonal Job</option>
				        <option value="Agency Job" >Agency</option>
				</select>
			</form>
		</div>
		<div id="TopRightCenter">
			<form name="Toprightcenter" method="post" id="FToprightcenter" class="FToprightcenter" 				action="">
				<p id="LabelsSecond">
                                Date Hired</p>
				<p style="margin:5px;padding:3px;margin-top:30px;">
                                Pay is based on</p>
				<p id="addressSecond">
                                Pay Period</p>
				<p id="addressSecond">
                                Next Pay Date</p>
				<p style="margin:5px;padding:3px;margin-top:20px;">
                                Second Pay Date</p>
				<p style="margin:5px;padding:3px;margin-top:30px;">
                                Other Income</p>
				<p id="addressSecond">
                                Net Pay Each Pay Period</p>		                                
				<p id="addressSecond">
                                Pay By</p>		                                
			</form>
		</div>
		<div id="TopRight">
			<form name="ETopright" method="post" id="FTopright" class="FTopright" action="">
 				<div style="margin:5px 0 5px 5px;color:green;">
				<input type="text" class="textBox" id="datehired"  name="datehired" /><br />date: mm/dd/yyyy</div>
				<select id="appprovince" style="margin:5px;height:25px;width:100px;" name="PayType">
					<option value="">- Select -</option>
					<option value="Salary" >Salary</option>
				        <option value="Hourly" >Hourly</option>
				</select>
				<select id="appprovince" style="margin:5px;height:25px;width:100px;" name="PayPeriod">
					<option value="">- Select -</option>
					<option value="Weekly" >Weekly</option>
					<option value="Bi-weekly" >Bi-weekly</option>
					<option value="Semi-monthly" >Semi-monthly</option>
				        <option value="Monthly" >Monthly</option>
				</select>
				<div style="margin:5px 0 5px 5px;color:green;">
				<input type="text" class="textBox" id="fdate"  name="firstpayday"/><br />date: mm/dd/yyyy</div>
				<div style="margin:5px 0 5px 5px;color:green;">
				<input type="text" class="textBox" id="sdate"  name="secondpayday"/><br />date: mm/dd/yyyy</div>				<select id="appprovince" style="margin:5px;height:25px;" name="OIncome">
					<option value="">- Select -</option>
					<option value="CTB" >Child Tax Benefit</option>
				        <option value="EI" >Employment Insurance</option>
				        <option value="WorkersCompensation" >Workers Compensation</option>
            				<option value="Disability" >Disability Income</option>
				        <option value="SocialWelfare" >Social Welfare,e.g.,O.W.</option>
				        <option value="CompanyPension" >Company Pension</option>
				        <option value="CPP" >Canada Pension</option>
				        <option value="OAS" >Old Age Security</option>
				        <option value="SELFEmployed" >Self Employed</option>
				</select>
	                       	<input type="text" class="textBox" id="fName"  name="TotalIncome" /><br />
				<select id="appprovince" style="margin:5px;height:25px;width:100px;" name="PayBy">
					<option value="">- Select -</option>
					<option value="DDeposit" >Direct Deposit</option>
				        <option value="Cheque" >Cheque</option>
				        <option value="Cash" >Cash</option>
				</select>
			</form>
		</div>
		<br style="clear: both;" /> <!-- Included to force the container to wrap the columns --> 
	</div>

	<!--EOD of Employment Information Section-->
	<div id="TitleInfo" class="TitleInfo"><h2>Your Banking Information - Step 3</h2></div>
	<!--Starting of banking Information Section-->
	<div id="Topcontainer">
		<div id="Bankingleft">
			<form name="BankLeft" method="post" id="BankLeft" class="FTopLeft" action="">
				<p id="BLabels">
                                Bank Name</p>
				<select id="appprovince" style="margin:2px;height:25px;width:160px;" name="Bankname">
					<option value="">- Select -</option>
					<option value="BMO" >Bank of Montreal</option>
					<option value="CIBC" >CIBC</option>
					<option value="HSBC" >HSBC Bank Canada</option>
					<option value="NationalBank" >National Bank of Canada</option>
				        <option value="RBC">Royal Bank of Canada</option>
					<option value="Scotiabank" >Scotiabank</option>
				        <option value="TDBank">TD Canada Trust</option>
					<option value="NonBank">Other Banks</option>
				</select>

				<p id="BLabels">
                                Branch Transit Number</p>
				<input type="text" class="textBox" id="fName"  name="BTransition" /><br/>
				<p id="BLabels">
                                Financial Institution Number</p>
				<input type="text" class="textBox" id="fName"  name="Institution" /><br/>
				<p id="BLabels">
                                Checking Account Number</p>
				<input type="text" class="textBox" id="fName"  name="CheckID" /><br/>
				<p>Cheque sample will be put here</p>		
			</form>
		</div>
		<div id="BankingCenter">
		<form name="BankCenter" method="post" id="BankCenter" class="FTopLeftCenter" action="">
				<p id="BankingID">
                                Online banking will make us easily verify your employment and increase your loan process dramatically</p>

				<p id="BankingID">
                                Debit Card Number    </p>
                            	<input type="text" class="textBox" id="BInfoName"  name="DebitID" /><br/>
				<p id="BankingID">
                                Online banking password</p>
                            	<input type="text" class="textBox" id="BInfoName"  name="onlinepwd" /><br/>
				<p id="BankingID">
                                Secure Question 1 (If have)</p>
                            	<input type="text" class="textBox" id="BInfoName"  name="SQ1" /><br/>
				<p id="BankingID">
                                Answer 1</p>
                            	<input type="text" class="textBox" id="BInfoName"  name="AS1" /><br/>
				<p id="BankingID">
                                Secure Question 2 (If have)</p>
                            	<input type="text" class="textBox" id="BInfoName"  name="SQ2" /><br/>
				<p id="BankingID">
                                Answer 2</p>
                            	<input type="text" class="textBox" id="BInfoName"  name="AS2" /><br/>
				<p id="BankingID">
                                Secure Question 3 (If have)</p>
                            	<input type="text" class="textBox" id="BInfoName"  name="SQ3" /><br/>
				<p id="BankingID">
                                Answer 3</p>
                            	<input type="text" class="textBox" id="BInfoName"  name="AS3" /><br/>
			</form>
		</div>
		<div id="BankingRight">
			<form name="BankRright" method="post" id="BankRight" class="FToprightcenter" action="">
				<p id="BankingID">
                                Since this is your nth loan application, your maximum loan amount will be LoanAmount here</p>
				<p id="BLabels">
                                Please choose your loan amount</p>
				<select id="appprovince" style="margin:2px;height:25px;width:160px;" name="LoanAmount">
				<!--need to determine the loan amount based on visit times, debug later-->
					<option value="">- Select -</option>
					<option value="A50" >50</option>
					<option value="A100" >100</option>
					<option value="A150" >150</option>
					<option value="A200" >200</option>
				        <option value="A250">250</option>
					<option value="A300">300</option>
				        <option value="A350">350</option>
					<option value="A400">400</option>
					<option value="A450">450</option>
					<option value="A500">500</option>
					<option value="A550">550</option>
					<option value="A600">600</option>
				</select>
				<p id="BLabels">
                                Loan cost is</p>
				<input type="text" class="textBox" id="fName"  name="LCost" /><br/>
				<p id="BLabels">
                                Loan Renewel</p>
				<input type="radio" name="loanrenewel" value="yes" id="renewel"/>Yes
                            	<input type="radio" name="loanrenewel" value="no" id="renewel"/>No<br/>
				<p style="width:200px;margin:2px;padding:1px;font-size:0.8em;border:solid 1px;">
                                Only interest, fees incurred are debited on your next pay day. Your loan principal is treated as a new Loan then</p>
				<p style="width:200px;margin:2px;padding:1px;font-size:0.8em;border:solid 1px;">
                                Loan principal and costs will be debited from your bank account on next pay day</p>

					                                
			</form>
		</div>
		
		<br style="clear: both;" /> <!-- Included to force the container to wrap the columns --> 
	</div>
	<!--EOD of Banking Information Section-->
	<div style="display:inline;float:left;width:720px;border:solid green;margin:5px;padding:5px;margin-bottom:20px;">
	<img src="/images/Canadian-Cheque.jpg" />
	<ol>
	<li>"12345"-This is 5-digit branch transist number</li>
	<li>"999"-This is 3-digit financial institution number</li>
	<li>"456789012"-This is chequeing account number</li>
	</ol>
	</div>

	<p style="padding-left:5px;color:black;"><h3>Please read the following agreement carefully before you sign</h3></p>
	<!--agreement here-->
	<iframe src="policy.php" frameborder="0" style="width:740px;height:150px;position:relative;left:5px;"></iframe>
	<p style="padding-left:5px;"><input type="checkbox" name="sign" value="yes" id="sign"/>I have read and agree to all terms and conditions of the Loan Agreement, and I also authorize
	Cash2u.ca to verify the accuracy of this information by, among other actions, calling a phone number provided by me.
	</p>

	<!--EOD of "TopSectionWrapper"-->


	<div style="text-align:center;"><input type="submit" id="action" name="action" value="Submit"/></div>



<div id="footer">
<div id="imlinks"><b><strong>Copyright ?2011 Cash2u.ca All rights reserved</strong></b></div>
</div>

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